Health Information Systems. A. The Contractor shall maintain a health information system that collects, analyzes, integrates, and reports data. (42 C.F.R. § 438.242(a); Cal. Code Regs., tit. 9, § 1810.376.) The system shall provide information on areas including, but not limited to, utilization, claims, grievances, and appeals. (42 C.F.R. § 438.242(a).) The Contractor shall comply with Section 6504(a) of the Affordable Care Act which requires that State claims processing and retrieval systems are able to collect data elements necessary to enable the mechanized claims processing and information retrieval systems in operation by the State to meet the requirements of section 1903(r)(1)(F) of the Social Security Act. (42 C.F.R. § 438.242(b)(1).)
B. The Contractor’s health information system shall, at a minimum:
1) Collect data on beneficiary and provider characteristics as specified by the Department, and on services furnished to beneficiaries as specified by the Department; (42 C.F.R. § 438.242(b)(2).)
2) Ensure that data received from providers is accurate and complete by:
a. Verifying the accuracy and timeliness of reported data, including data from network providers compensated on the basis of capitation payments; (42 C.F.R. § 438.242(b)(3)(i).)
b. Screening the data for completeness, logic, and consistency; and (42 C.F.R. § 438.242(b)(3)(ii).)
c. Collecting service information in standardized formats to the extent feasible and appropriate, including secure information exchanges and technologies utilized for quality improvement and care coordination efforts. (42 C.F.R. § 438.242(b)(3)(iii).)
3) Make all collected data available to the Department and, upon request, to CMS. (42 C.F.R. § 438.242(b)(4).)
C. The Contractor’s health information system is not required to collect and analyze all elements in electronic formats. (Cal. Code Regs., tit. 9, § 1810.376(c).)
Health Information Systems. The Contractor shall establish and maintain web-based portals with appropriate security features that allow referrals, requests for prior authorizations, and encounter submission, for GFS services. The Contractor may use its Medicaid website as long as the website includes information on GFS services. The Contractor shall include information on how to access GFS services, including crisis contact information and toll-free crisis telephone numbers.
Health Information Systems. 2.8.12.1. The Contractor shall maintain a health information system that collects, analyzes, integrates and reports data. The system shall provide information on areas including, but not limited to:
2.8.12.1.1. Utilization.
2.8.12.1.2. Grievances and appeals. 2.8.12.1.3. Third party liability.
2.8.12.2. The Contractor shall make all collected data available to the Department, the Department’s designee and to CMS upon request.
2.8.12.2.1. DEVLIVERABLE: Health Information Data.
2.8.12.2.2. DUE: Upon Request of the Department, the Department’s designee or CMS.
Health Information Systems. Provider shall maintain a health information system that complies with the requirements of 42 CFR 438.242 and provides the information necessary to meet Provider’s obligations under the Agreement and this Appendix.
Health Information Systems. Contractor shall establish and maintain a health information system that complies with the requirements of OCIO Security Standard 141.10, and the Data, Security and Confidentiality Exhibit, and provides the information necessary to meet Contractor’s obligations under this Contract. OCIO Security Standards are available at: xxxxx://xxxx.xx.xxx.
Health Information Systems. The Contractor shall establish and maintain, and shall require Subcontractors to maintain, a health information system that complies with the requirements of OCIO Security Standard 141.10, and the Data, Security and Confidentiality Exhibit, and provides the information necessary to meet the Contractor’s obligations under this Contract. OCIO Security Standards are available at: xxxxx://xxxx.xx.xxx. The Contractor shall have in place mechanisms to verify the health information received from Subcontractors. The Contractor shall: Collect, analyze, integrate, and report data. The system must provide information on areas including, but not limited to utilization, and fund availability by service type and fund source. Verifying the accuracy and timeliness of reported data; Screening the data for completeness, logic and consistency; and Collecting service information on standardized formats to the extent feasible and appropriate. Make all collected data available to HCA upon request, to the extent permitted by the HIPAA Privacy Rule (45 C.F.R. Part 160 and Subparts A and E of Part 164 and RCW 70.02.005). Establish and maintain protocols to support timely and accurate data exchange with any Subcontractor that will perform any delegated functions under the Contract. Adding information to the portal shall not be a barrier to providing a necessary Crisis Service. Establish and maintain web-based portals with appropriate security features that allow referrals, requests for prior authorizations, claims/encounters submission, and claims/encounters status updates. Have information systems that enable paperless submission, automated processing, and status updates for prior authorization and other utilization management related requests. Maintain behavioral health content on a website that meets the following minimum requirements. Public and secure access via multi-level portals for providing web-based training, standard reporting, and data access for the effective management and evaluation of the performance of the Contract and the service delivery system as described under this Contract. The Contractor shall organize the website to allow for easy access of information by Individuals, family members, network providers, stakeholders and the public in compliance with the Americans with Disabilities Act. The Contractor shall include on its website, at a minimum, the following information or links: Hours of operations; How to access information on Contracted Services and toll-...
Health Information Systems. The contractor shall maintain a health information system that collects, analyzes, integrates, and reports data and can achieve the objectives of 42 CFR 438.242 and Health Insurance Portability and Accountability Act (HIPAA) requirements.
Health Information Systems. The Contractor shall maintain a health information system that collects, analyzes, integrates and reports data. The system shall provide information on areas including, but not limited to, utilization, grievances and appeals, encounters and Disenrollment. The Contractor shall collect data on Member and Provider characteristics and on services furnished to Members. The Contractor shall make all collected data available to the Department and to CMS upon request. The Contractor shall ensure that the data received from providers is accurate and complete, by:
Health Information Systems. The Contractor shall establish and maintain, and shall require Subcontractors to maintain, a health information system that complies with the requirements of OCIO Security Standard 141.10, and the Data, Security and Confidentiality Exhibit, and provides the information necessary to meet the Contractor’s obligations under this Contract. OCIO Security Standards are available at: xxxxx://xxxx.xx.xxx. The Contractor shall have in place mechanisms to verify the health information received from Subcontractors. The Contractor shall:
7.6.1 Collect, analyze, integrate, and report data. The system must provide information on areas including, but not limited to utilization, and fund availability by service type and fund source.
7.6.2 Ensure data received from providers is accurate and complete by: 7.6.2.1 Verifying the accuracy and timeliness of reported data;
Health Information Systems. The Contractor shall maintain and shall require subcontractors to maintain a health information system that complies with the requirements of 42 CFR 438.242 and provides the information necessary to meet the Contractor’s obligations under this Contract. The Contractor shall have in place mechanisms to verify the health information received from subcontractors. The health information system must:
12.19.1. Collect, analyze, integrate, and report data. The system must provide information on areas including but not limited to, utilization, grievance and appeals, and disenrollments for other than loss of Medicaid eligibility.
12.19.2. Ensure data received from providers is accurate and complete by:
12.19.2.1. Verifying the accuracy and timeliness of reported data;
12.19.2.2. Screening the data for completeness, logic, and consistency; and
12.19.2.3. Collecting service information on standardized formats to the extent feasible and appropriate.
12.19.3. The Contractor shall make all collected data available to DSHS and the Center for Medicare and Medicaid Services (CMS) upon request.
